This speech was published under
the 2010 to 2015 Conservative and Liberal Democrat coalition government

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Speech by International Development Minister Stephen O’Brien at APPG on HIV & AIDS/ Stop AIDS (RED) on World AIDS Day

Thank you. First of all I would like to thank the All Party Parliamentary Group on AIDS and RED for inviting me to make some short remarks and for organising such a fantastic event to mark World AIDS Day 2010. Today we pay tribute to the millions of people who have lost their lives to AIDS, to those living with HIV and to people from all levels of society, who have fought relentlessly for action against the epidemic.

Let me say at the outset that the Coalition Government remains 100% committed to this fight. Yes, we have new priorities as well - such as malaria. But that in no way diminishes our commitment to this agenda.

The APPG likewise plays an important role in the UK’s response to the epidemic by bringing together members of parliament across the political spectrum and working with our strong civil society network to sustain UK taxpayers’ support for tackling AIDS. They hold us to account for what we promise to deliver. I would also like to commend RED’s efforts to raise funds through private-sector partnerships to address AIDS in Africa. The UK believes that the private sector has a vital role in a sustained response.

I would like to say a few words on two issues - first about how the UK government will contribute to end mother to child transmission and secondly how we intend to move forward in response to the epidemic over the months and years ahead. But let me first reflect on the progress we’ve made in the response so far.

We have seen enormous progress - over 5 million people on treatment (13 times more the number of people that had access in 2004!); an epidemic that has stabilised in most regions; a 19% reduction in the number of new infections since 1999. And there’s more good news in the Global Report that UNAIDS published last week. In 33 countries HIV prevalence has fallen by more than 25% between 2001 and 2009 - many of these countries are in sub-Saharan Africa. And HIV prevalence has also fallen by more than 25% among young people in 15 of the most affected countries as young people have adopted safer sexual practices - showing prevention messages are getting through and saving lives.

But there is bad news too. More than 7,000 people get infected with HIV every day and an estimated 10 million are in need of treatment, but not getting it. And UNAIDS report that in five countries of Eastern Europe and Central Asia, where the epidemic is driven amongst marginalized groups, HIV prevalence has risen by 25% since 2001. We now see two epidemics - that in sub-Saharan Africa, with a female face, and that elsewhere, where we increasingly need to reach men who have sex with men, sex workers, prisoners and drug users. That is why we must continue to defend the rights of marginalised groups to protect themselves from HIV for example through supporting harm reduction programmes that ensure drug users get access to clean needles. The APPG has a proud record in this area. The UK Government, too, will continue to be an advocate for these groups.

But let me turn to the matter that concerns us today - an estimated 370,000 children contracted HIV through mother to child transmission in 2009. This is a significant reduction from 500,000 in 2001 - but this level of entirely avoidable infection is still unacceptable. These numbers tell us that there is still much to do to eliminate paediatric AIDS.

As you know, the UK Government have committed to allocating 0.7 of our Gross National Income for overseas AID by 2013 and have ring-fenced our budget. This is a historical commitment. We have also put women and children’s healthat the heart of our international development agenda and we expect that our Commitments made on women and children’s health will contribute to the survival of at least 50,000 more women in pregnancy and childbirth and 250,000 newborn babies and to provide 10 million more couples with access to comprehensive family planning.

The UK Government wholeheartedly supports the call for the virtual elimination of paediatric AIDS and we are working with others to scale up prevention of mother to child transmission services. To reach this goal, we need to** adopt the comprehensive approach** recommended by the World Health Organization, and we are committed to doing so by focusing where we have comparative advantage. This is on primary prevention of HIV among women of child-bearing age, and on prevention of unintended pregnancies among women living with HIV through our investments in family planning.

Prevention of mother-to-child transmission of HIV is not just about provision of anti-retrovirals. Making choices through family planning is a key element of the package- but many women do not have access to modern methods of contraception and cannot choose whether and when and how many children to have, let alone choose to do this safely. And we know that the unmet need for family planning among HIV positive women is higher than among HIV negative women (as high as 51 to 90%). Most paediatric infections occur in Sub-Saharan Africa, which accounts for more than 91% of all pregnant women living with HIV. We expect to make a significant contribution to the goal of eliminating paediatric AIDS in Africa through our investments in family planning and commitment to double the numbers of mothers and babies lives saved.

There are real challenges here. How do we change behaviour? We know this is not easy - but I’d suggest it’s largely through giving people - particularly young women like Esnart who will shortly be telling you her story - the right information and supporting them to make real choices about their health and their lives by addressing factors that influence behaviour. We know that programmes that do this do work but we also need to make prevention programmes more effective, particularly in generalised epidemics. To do this, we need to strengthen the evidence by rigorously evaluating what we do.

The UK government is strongly committed to empowering women and girls, by focusing on their sexual and reproductive health and rights, and addressing the underlying drivers of the AIDS epidemic such as gender inequality, gender based violence and poverty. The latest UNAIDS report tells us that young women aged 15-24 in Sub-Saharan Africa are as much as 8 times more likely than men to be HIV positive. This is alarming, and clearly, we must do better to protect women and girls. This is why we will test and support innovative approaches such as cash transfers to reduce women and girls’ HIV risk - as well as getting more girls into school, something this Government is determined to support.

We will use the Reproductive, Maternal and Newborn Health Framework for Action (which we will publish later this month) as the Coalition Government’s key mechanism to prioritise the health of women and children. The Framework will support service delivery across the continuum of care needed to improve the health of women and children, including Prevention of Mother to Child Transmission. And we will continue to support the implementation of the UN Secretary General Global Strategy for Women’s and Children’s Health which is based on delivering a comprehensive, integrated package of essential interventions and services.

Of course - we can’t do this in isolation. I’m proud of the UK’s success in working through coalitions and alliances - of punching above our weight by persuading others of the case for action. That is something I’m keen to build on.

So I want to close by renewing a commitment. This World AIDS Day marks the close of 2010 - the target the world set for universal access to HIV prevention, AIDS treatment, care and support. In June at Muskoka, the G8 reaffirmed its commitment to come as close as possible to this goal. Progress against these targets will be reviewed at a UN General Assembly special session in June next year. The Coalition Government will play its part in taking this forward. We have not given up.

As many in this room will know, we have been clear that the detail of our future plans depends on the outcome of the Multilateral and Bilateral Aid Reviews - which the SoS commissioned to ensure that every pound of UK aid buys 100 pence of value.

We will set out the UK Government’s position on HIV in the spring, in the light of the findings of these reviews. As part of this we will need to articulate where the UK can add most value to the global response to HIV. This will inform our position at the UN special session in June. Input from the APPG, and other stakeholders, will be key to getting this right and I am asking my officials to work with you, as we develop and confirm our thinking over the coming months.